Abstract
BackgroundFull breastfeeding is the ultimate aim for preterm infants to ensure they receive the full benefits of human milk however, preterm infants face a number of challenges associated with their immaturity and associated morbidities. In order to facilitate oral feeding, it is essential to have a sound knowledge of the sucking dynamics of the breastfed infant. The aim of this study was to measure and describe the sucking dynamics of the preterm breastfeeding infant.MethodsA prospective cross sectional observational study was carried out at King Edward Memorial Hospital, Perth. 38 mothers and their preterm infants (birth gestation age: 23.6–33.3 weeks; corrected gestation age 32.7 to 39.9 weeks) were recruited. Intra-oral vacuum levels, tongue movement and milk intake for a single breastfeed was measured. Statistical analysis employed linear regression and linear mixed effects models.ResultsSynchronised ultrasound and intra-oral vacuum measurements show that the preterm infant generates vacuum by lowering their tongue in a parallel fashion, without distortion of the nipple/nipple shield. Baseline (B), mean (M) and (P) peak suck burst vacuums weakened over the course of a feed (B: p = 0.015; M: p = 0.018; P: p = 0.044) and mean and peak vacuums were weaker if the mother fed with a nipple shield (M: p = 0.012; P: p = 0.021). Infant milk intakes were higher when infants sucked for longer (p = 0.002), sucked for a greater proportion of the feed (p = 0.002), or had a greater sucking efficiency (p < 0.001).ConclusionsBreastfeeding preterm infants generated intra-oral vacuum in the same manner as term infants. Nipple shields were associated with weaker intra-oral vacuums. However, vacuum strengths were not associated with milk intake rather time spent actively sucking was related to milk volumes. Further research is required to elucidate factors that influence preterm infant milk intake during breastfeeding.
Highlights
Full breastfeeding is the ultimate aim for preterm infants to ensure they receive the full benefits of human milk preterm infants face a number of challenges associated with their immaturity and associated morbidities
Infants that had reached full suck feeds were older (CGA; p = 0.003) and use of a nipple shield was not associated with corrected gestation age (CGA) (p = 0.34)
Milk intakes were higher when infants sucked for a longer time (p = 0.002), spent a greater proportion of the feed sucking (p = 0.002), or had a greater sucking efficiency (p < 0.001)
Summary
Full breastfeeding is the ultimate aim for preterm infants to ensure they receive the full benefits of human milk preterm infants face a number of challenges associated with their immaturity and associated morbidities. Breastfeeding provides advantages for both the mother and infant [1,2,3,4,5] that cannot be replicated by either artificial milks or artificial feeding methods [6]. Often the preterm infant is too ill to breastfeed immediately, and is tubefed while oral feeding is established. During this time the initiation and establishment of a maternal milk supply is a priority [24]. Achieving and maintaining a plentiful milk supply is hampered by a tendency for the initiation of lactation to be delayed and less milk to be expressed compared to mothers of term infants [25, 26]. There is a strong relationship between the frequency of pumping and milk volume [28, 29]
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